Quantitative assessment of pancreas R2* in cirrhosis with systemic iron overload: relationship with serum iron parameters and metabolic complications.

BACKGROUND: Although pancreatic iron deposition is linked to metabolic dysfunction in hereditary hemochromatosis and transfusional iron overload, its significance in cirrhosis with secondary iron overload remains unclear. We quantitatively assessed pancreatic R2* in cirrhotic patients with and without systemic iron overload using magnetic resonance imaging (MRI)-based R2* relaxometry, evaluated its correlation with hepatic iron content and serum iron parameters, and examined its association with 5-year metabolic outcomes. METHODS: This retrospective observational cohort study included 170 cirrhotic patients who underwent magnetic resonance elastography (MRE) with multi-echo proton density fat fraction (PDFF)/R2* mapping between January 2018 and October 2024. Pancreatic and liver R2* values were measured. Patients were categorized into iron overload and normal iron status based on iron parameters [transferrin saturation (TSAT) >45% and ferritin >200 µg/L in women and TSAT >50% and ferritin >300 µg/L in men]. Correlations between pancreatic R2*, serum iron parameters, liver function markers, and MRI-derived measures were analyzed. The 5-year cumulative incidence of metabolic complications including dyslipidemia, prediabetes, and type 2 diabetes mellitus (T2DM) was assessed. RESULTS: Pancreatic R2* values were higher in patients with iron overload compared to those with normal iron status, but this difference was observed only in patients with alcoholic liver cirrhosis {26.2 [interquartile range (IQR), 19.5-37.9] vs. 34.7 [IQR, 24.8-345.3] s-1, P=0.001}. Among patients with iron overload, pancreatic R2* values correlated with serum ferritin {adjusted r=0.175 [95% confidence interval (CI): 0.016-0.389], P=0.014} and total iron-binding capacity (TIBC) [adjusted r=-0.175 (95% CI: -0.369 to -0.015), P=0.018] but showed no correlation with liver iron concentration (LIC) [adjusted r=0.292 (95% CI: -0.030 to 0.558), P=0.058]. In this subgroup, pancreatic R2* values also correlated with higher Child-Pugh [adjusted r=0.371 (95% CI: 0.039-0.645), P=0.014] and Model for End-Stage Liver Disease (MELD) scores [adjusted r=0.383 (95% CI: 0.098-0.622), P=0.011]. However, pancreatic R2* did not predict the development of dyslipidemia, prediabetes, or T2DM (all P>0.05). CONCLUSIONS: Pancreatic R2* values correlated with serum iron parameters and liver disease severity, but not with LIC or future metabolic complications.